Hunger, waiting time and transport costs: Time to confront challenges to ART adherence in Africa

International audienceAdherence levels in Africa have been found to be better than those in the US. However around one out of four ART users fail to achieve optimal adherence, risking drug resistance and negative treatment outcomes. A high demand for 2nd line treatments (currently ten times more expensive than 1st line ART) undermines the sustainability of African ART programs. There is an urgent need to identify context-specific constraints to adherence and implement interventions to address them. We used rapid appraisals (involving mainly qualitative methods) to find out why and when people do not adhere to ART in Uganda, Tanzania and Botswana. Multidisciplinary teams of researchers and local health professionals conducted the studies, involving a total of 54 semi-structured interviews with health workers, 73 semi-structured interviews with ART users and other key informants, 34 focus group discussions, and 218 exit interviews with ART users. All the facilities studied in Botswana, Tanzania and Uganda provide ARVs free of charge, but ART users report other related costs (e.g. transport expenditures, registration and user fees at the private health facilities, and lost wages due to long waiting times) as main obstacles to optimal adherence. Side effects and hunger in the initial treatment phase are an added concern. We further found that ART users find it hard to take their drugs when they are among people to whom they have not disclosed their HIV status, such as co-workers and friends. The research teams recommend that (i) health care workers inform patients better about adverse effects; (ii) ART programmes provide transport and food support to patients who are too poor to pay; (iii) recurrent costs to users be reduced by providing three-months, rather than the one-month refills once optimal adherence levels have been achieved; and (iv) pharmacists play an important role in this follow-up care

Psychology and poverty reduction: a global special Issue

A “global special issue” on poverty brought together 9 international psychology journals during 2010 through 2013. The purpose was to highlight psychology’s contribution toward the Millennium Development Goals (MDGs). These goals are rooted in the “capabilities approach” and highlight the importance of fostering environments that support 3 core domains: health, basic education, and income. Here, we analyze what the global special issue contributed. As a whole the global special issue provided an account of “how” psychology engages with poverty and poverty reduction. First, the global special issue, more than other research on poverty, was focused on lower- and middle-income settings. Second, while the content of the articles could be coded into 3 specific domains (health/well-being, education/development, and society/work), the vast majority of the articles straddled more than 1 category. Third, the contents of the global special issue could be organized in terms of the type of contribution: that is, practicality, theory, description, and advocacy. We highlight the importance of addressing wider situational and sociopolitical structures that constrain capability and potential, without losing sight of the person. Psychology might (a) concentrate resources on finding out what actually works to enable poverty reduction; and (b) apply what we know to ensure that research on poverty reduction is more informative and compelling to community stakeholders, organizations, and policymakers. Such an “implementation science” could advance poverty reduction and human development. (PsycINFO Database Record (c) 2014 APA, all rights reserved

Choice-Disability and HIV Infection: A Cross Sectional Study of HIV Status in Botswana, Namibia and Swaziland

Interpersonal power gradients may prevent people implementing HIV prevention decisions. Among 7,464 youth aged 15–29 years in Botswana, Namibia and Swaziland we documented indicators of choice-disability (low education, educational disparity with partner, experience of sexual violence, experience of intimate partner violence (IPV), poverty, partner income disparity, willingness to have sex without a condom despite believing partner at risk of HIV), and risk behaviours like inconsistent use of condoms and multiple partners. In Botswana, Namibia and Swaziland, 22.9, 9.1, and 26.1% women, and 8.3, 2.8, and 9.3% men, were HIV positive. Among both women and men, experience of IPV, IPV interacted with age, and partner income disparity interacted with age were associated with HIV positivity in multivariate analysis. Additional factors were low education (for women) and poverty (for men). Choice disability may be an important driver of the AIDS epidemic. New strategies are needed that favour the choice-disabled

Strategic guidelines for social impact investments of the Departrment of Science & Technology

Commissioned by the Department of Science and Technology, Octobe